A Training and Fidelity Model to Move and Scale Evidence-based Dementia Care and Caregiver Support Programs into Practice: The Case for COPE in PACE service settings

本NIA第一阶段研究旨在解决两个主要障碍， 将循证痴呆症护理和护理人员支持计划纳入长期护理环境：（1） 缺乏精简的、用户友好的和经过测试的培训模式，以及（2）缺乏可扩展的， 在“真实的世界”环境中精确测量保真度的实用过程。研究目的 是为了确定一个在线培训计划是否是相同的或更好地改善 干预者对痴呆循证计划（科普）和痴呆患者忠诚度 与高强度的面对面传统培训形式相比，到 为了实现这些目标，我们将开发一种在线的、原则驱动的方法， 科学模拟和最佳实践以及可扩展的方法，以评估对科普的忠诚度， 应用计算语言学技术。然后我们将进行一项非劣效性试验， 所有包容性老年人护理计划（PACE）组织随机分配到 训练条件。PACE工作人员将在培训后对其忠诚度结果进行评估。二合体 痴呆症患者及其护理人员将在科普后4个月进行评估 实施功能，神经精神症状，生活质量和照顾者负担。 该项目的研究结果将为大规模的第三阶段至第四阶段， 在美国各地的PACE环境中进行科普的实用性试验。调查结果也将作为一个 用于指导开发实用的、可扩展的培训和保真度流程的模型 监测在其他长期护理环境和其他基于证据的支持计划。

This NIA Stage I study is designed to address two leading barriers to implementation of evidence-based dementia care and caregiver support programs into long-term care settings: (1) lack of streamlined, user-friendly, and tested training modalities, and (2) lack of scalable, practical processes to accurately measure fidelity in “real world” settings. The aims of the study are to determine whether an online training program is the same or better in improving interventionist fidelity to an evidence based dementia program (COPE) and dementia patient outcomes when compared to a high intensity face-to-face traditional form of training. To accomplish these aims we will develop an online, principle-driven approach using state-of-the- science simulation and best practices and a scalable approach to assess fidelity to COPE by applying computational linguistics techniques. We will then conduct a noninferiority trial in Programs for All Inclusive Care for Elders (PACE) organizations randomly assigned to the training conditions. PACE staff will be evaluated post training on their fidelity outcomes. Dyads of persons with dementia and their caregivers will be evaluated at 4 months post COPE implementation on function, neuropsychiatric symptoms, quality of life, and caregiver burden. The findings from this project will lay the essential groundwork for a large scale, Stage III-IV, pragmatic trial of COPE in PACE settings throughout the US. Findings will also serve as a model for guiding the development of practical, scalable processes for training and fidelity monitoring in other long-term care settings and for other evidence-based support programs.